Diethylstilboestrol (DES) exposure in utero

Area of Science:

• Gynecology
• Reproductive Health
• Oncology

Background:

• Diethylstilbestrol (DES) is a synthetic estrogen previously prescribed to prevent miscarriage.
• In utero exposure to DES is associated with an increased risk of certain reproductive tract abnormalities and cancers.
• The DES Referral Clinic was established to monitor patients with suspected in utero DES exposure.

Purpose of the Study:

• To review the clinical findings of the first 200 patients attending the DES Referral Clinic.
• To assess the prevalence of DES-related abnormalities in this cohort.
• To evaluate diagnostic methods for detecting vaginal adenosis.

Main Methods:

• Clinical review of 200 patients attending the DES Referral Clinic.
• Assessment for clinical stigmata of DES exposure.
• Cytological examination of vaginal smears and Lugol's iodine staining for screening adenosis.
• Colposcopy recommended for suspected cases.

Main Results:

• No cases of clear-cell adenocarcinoma were detected.
• Fifteen percent of patients showed no clinical stigmata of DES exposure.
• Vaginal adenosis was diagnosed in 41% of patients.
• Cytological examination of vaginal smears was found to be unreliable for routine adenosis screening.
• Lugol's iodine staining of the cervix and vagina proved a more reliable screening test.

Conclusions:

• Regular clinical monitoring is essential for individuals with in utero DES exposure.
• Vaginal adenosis is a common finding, necessitating reliable screening methods.
• Lugol's iodine staining and colposcopy are recommended for the detection and management of DES-related abnormalities.